Sunday, August 13, 2006

Medical transcription is the job of typing voice recordings made by physicians or other healthcare professionals into medical reports and correspondence. The people who make such transcriptions are called medical "transcriptionists": transcribers who produce discharge summaries, physical examinations reports, patients' history reports, operating room reports, consultation notes, diagnostic imaging studies, autopsy reports, and referral letters at home or in the office. They listen to recordings on a special headset and use a foot pedal to pause the recording when desired. As they listen, they type the text using word processing software, organize the material into a set format, and then return transcribed documents to the dictator for review and signature or correction. They use their understanding of medical terminology, anatomy and physiology, diagnostic procedures, and treatment to create accurate reports, says Lynn Shniper in her article, Medical transcritionists: Making medical histories, in the Fall 2001 edition of the Occupational Outlook Quarterly. They translate medical abbreviations and jargon into their expanded forms and check their spellings and meanings by consulting standard medical reference materials. The more experienced of them spot inconsistencies or mistakes, such as misspoken prescriptions, in a medical report and verify the correct information with the dictator. Their ability to understand and correctly transcribe patient assessments and treatments reduces the chance that patients will receive ineffective or harmful care.

In the United States, most medical transcribers receive special training. Employers usually prefer to hire those who have postsecondary education in medical transcription, which is available through many vocational schools, community colleges, and distance-learning programs. Demand for transcribers' services is so high that U.S. hospitals, physicians, business support services, and medical transcription companies regularly subcontract transcribing jobs at home and abroad. In its Occupational Outlook Handbook for 2004-2005, the United States Bureau of Labor Statistics says "Employment of medical transcriptionists is projected to grow faster than the average for all occupations through 2012." The United States' growing and aging population requires medical documentation that can be shared by providers, third-party payers, regulators and consumers, but the increasing volume of transcription work being contracted out overseas will not reduce the need for well-trained medical transcribers at home.

Outside the United States, India is the recognized leader in providing medical transcription services to U.S. institutions. But the Philippines is fast catching up as the country of choice for offshore transcriptions as a result of its large pool of healthcare professionals. "India is the leading provider because they offer cheap labor, but the Philippines has the competitive edge as we can provide quality service at reasonable prices," says Oliver Juanir, co-owner of Advatech Medical Transcription Specialists. "We started just several months ago, but clients continue to pour in."

Juanir, an entrepreneur on the lookout for business opportunities, was surfing the Web when he stumbled on medical transcription services and then did some research. Next, he pitched his business plan to several investors and got one to put up P2 million to buy equipment (top-of-the-line personal computers, file transfer protocol or FTP servers, medical dictionaries, and computer software), plug into the Internet, and rent office space. He incorporated Advatech in August and spent two months recruiting staff. "I made it a point to recruit only those who had experience," he says. He e-mailed medical transcription companies in the U.S., and once Advatech passed some tests for minimum output, clients, all medical transcription companies, started calling. It started with four transcribers to work for three doctors initially, but in four months it hired eight more to serve 20 doctors in four U.S. hospitals. "We're still hiring as projects continue to pour in," says Juanir.

Advatech's transcribers start work by downloading audio files from the FTP server at 7 a.m. They then transcribe the files before forwarding the finished work to the editors for checking, observing a 12-hour deadline for each project. Medical transcription companies are paid five to eight U.S. cents per line of about 65 characters transcribed, but Advatech charges only four to seven U.S. cents to get more clients. It sets a 500-line daily quota for its transcribers-those exceeding their quota receive a commission-and gets paid monthly for its services.

Many medical transcribers get to like what they do. Michelle Diamante has been transcribing medical reports at home for three years, and she likes it because "You're not forced to work an eight-hour job. You work at your own pace and earn in dollars." She uses her speed, accuracy, and knowledge of medical terms to thrive in her calling, something she'd stumbled on as a fresh graduate of physical therapy. "It was hard to get a job in hospitals then, so I applied with a medical transcription company," she says. She trained for two months after she got the job, and then quit after a year and a half to transcribe at home using referrals from her officemates to secure projects. All she needed to get started were a PC, an Internet connection, and a foot pedal to control dictation speed, and when she transcribed her first test files and passed, she resumed work as a medical transcriber in the comfort of home. The outsourcing company simply provided her with a user name and password so she could download audio files from an encrypted website. "Since I operate in the same time zone as that of the US, I usually work from 8 p.m. onwards depending on the amount of work I would like to take in," she says. Today, Diamante works as an editor of medical files transcribed by others. Medical transcribers get paid P20,000 to P50,000 a month depending on the amount of work they do, she says, adding the outsourcing company typically credits the money they've earned to their bank accounts. "We're usually given a 24-hour deadline. The more transcribed work you edit, the more you get paid."

Myla Jane Reyes, another home-based transcriber, and a physical therapist like Diamante, says there's a big demand for medical transcription services in the Philippines. "The business is good and work comes even on weekends and holidays," she says. Reyes trained for six months before she was allowed to do transcription work by one of the pioneer medical transcription firms in the country. She stayed with that company for two years until it closed, and then she joined another company before she decided to do extra transcription work at home on the advice of a friend, who had come across an Internet ad looking for home-based medical transcribers. "In 2002 I applied for the job and passed their online exam, so I pursued it," she says. For a whole year, Reyes transcribed in the office by day and at home at night and on weekends. "I had a hard time choosing between office work and home-based transcription as it was not popular back then," she says, but after a year she decided to quit her regular job and concentrated on home-based transcribing and editing. "The risk I took was worth it," she says. "I never had regrets choosing home transcription."